Lung cancer, the morbidity is so quickly increasing so in 2005 we had the number per year we had about 630,000 new cases per year but last year this number increased to 730,000 cases, this so quickly increasing. So this is the morbidity increasing. Another thing, the lung cancer histology subtype also changed. Squamous carcinomas went down and adenocarcinomas are increasing, this is the second point. The third point, tobacco not related to cancer such as female adenocarcinoma is also increasing, this is different from other countries.
Is the role of the surgeon changing?
We have microsurgery, this is non-invasive surgery so quickly changing. In China now 60% of thoracic surgeons perform [??] surgery, that means uniport or double port. Now open surgery is much less than before so this is a great change. Based on this, the surgery changes, the patient takes then less damage from the surgery. It also changed our priority in cancer treatment.
In China how has chemotherapy played a part in surgery?
In China we have developed the so-called modality treatment team. This means that in one cancer centre including the thoracic surgeon, the medical oncology and the radiotherapy team and also translational research, all the team members are all together. So, one, the lung cancer patient into this cancer centre then we have to meet them, multi-therapy discussion and give the patient the best treatment. So this is also a change than before.
Are there patients receiving both immunotherapy and chemotherapy prior to surgery?
The past twenty years everybody knows and also the standard treatment if the lung cancer is stage 2 or 3 and then after surgery, so give the patient adjuvant chemotherapy. But now something changed, all the surgeons, all the patients asks one question – chemotherapy before the surgery or after surgery? So this is the one question, very good question. We have one clinical trial and then these results were released at this year’s ESMO meeting. We are comparing the neoadjuvant versus the adjuvant treatment so we found that in the long term the adjuvant treatment, adjuvant chemotherapy, may be better than neoadjuvant treatment. So this is what the standard treatment, adjuvant chemotherapy. But some special institutions we need neoadjuvant, before the surgery, such as advanced disease and also the [?? 3:44] difficult to perform. Then in this situation we give the patient chemotherapy before the surgery. About the immunotherapy, this is very interesting, very attractive the issues, but now in China we have now immunotherapy before the surgery treatment because now a PD-1 drug is approved in China.
Are you optimistic about the future of lung cancer treatment?
The biggest change in China is the reclassification for the lung cancer patients. So before we had divided patients by the histology – the squamous carcinoma and the adenocarcinoma, the small cell lung cancer, but from two studies years later because the molecular showed better so quickly now we divide the patients in new classifications by the molecular profile such as that in Asia, in China, we test the patient’s EGFR mutation and the ALK translocation. So because in China this is very, very important because we have 40% of patients are EGFR mutant patients so this is why we need to test the EGFR mutation. So if the patient, the EGFR mutation patient, the treatment is so very different such as in the early stage we need to consider the EGFR mutation patient after surgery we give the patient EGFR TKI or chemotherapy. So that’s something we also want to try and maybe the results will be released next year. Also for advanced disease in the EGFR mutated patient in the fourth line treatment we don’t give the patient chemotherapy, we don’t give the EGFR TKI inhibitor. So this is a great change.
